Provider Demographics
NPI:1174191639
Name:MICHI NUTRITION
Entity Type:Organization
Organization Name:MICHI NUTRITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMIOKA
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, RDN, IFNCP
Authorized Official - Phone:551-216-4761
Mailing Address - Street 1:71 EVERETT RD
Mailing Address - Street 2:
Mailing Address - City:DEMAREST
Mailing Address - State:NJ
Mailing Address - Zip Code:07627-1228
Mailing Address - Country:US
Mailing Address - Phone:551-216-4761
Mailing Address - Fax:
Practice Address - Street 1:71 EVERETT RD
Practice Address - Street 2:
Practice Address - City:DEMAREST
Practice Address - State:NJ
Practice Address - Zip Code:07627-1228
Practice Address - Country:US
Practice Address - Phone:551-216-4761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty